Online Chat Counseling Order Form

1. Fill in your name, phone number, email address and the name of the person to receive counseling if not you below. This is so that we can contact you if there is any problem.
2. You'll be forwarded to a secure web page provided by our credit card processing provider. Fill in all the required fields on that form.
3. Once your order is approved, we will contact you to get some pre-session information from you (to help your counselor better understand how he/she can help you) and answer any questions you may have. During this contact we will also give you instructions on how to start your chat counseling sessions. Normally our scheduling manager will be in contact with you within 1 business day (Monday-Friday).

Your order total is: $85.00.

If you have any problems with this form or the ordering process, you can email us or call our office Monday - Friday from 9:00 AM - 6:00 PM US Mountain Time.